? Mochi - Low AMPS number (28) - should I hold off?

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Mochi & Me

Mochi & Me

Member Since 2017
Hello all,

I'm new here, so I hope this is the right place to post this question.

Mochi had a HYPO incident Tues and then bounced. I gave him a slightly reduced dose of insulin (glargine) last night. This morning his BG was 34, so I retested and got 28 - but he's not showing any signs of HYPO. At those numbers Tues he was acting drunk and pretty unresponsive. I just set out his wet food (about 15% carbs) and he's eating. Should I hold off his shot? Should I retest? Should I call his vet?

A little background. We just adopted Mochi a couple weeks ago (technically we're fostering him). I haven't been the one taking him to his vet apts, but we do have one scheduled for this evening that I will be going to with Mochi's former foster mom from the rescue. I'm afraid to skip doses or adjust them much when I haven't even met his vet yet, but I also don't want to end up with him having another incident.

As I type this he's sniffing all over the place and that's one of the things he was doing Tuesday so I'm really worried.
 
Skip the shot. Keep testing to be sure he's coming back up to safe numbers. Have you decided if you are doing TR or SLGS?

ETA: (edited to add) Please do 1 unit tonight if he's in a good number. I think 2 and 1.75 units are too high for Mochi.
 
Hi there, can you add your AMPS number in the title? I can't see what meter you are using, but to me 34/28 is REALLY low, even if he is not showing symptoms. I believe I've read that not even the most experienced folks shoot below 50. If it were my cat, I'd be giving him some karo syrup and feeding HC food at that number. I don't mean to alarm you, but I would actually put the 911 in the thread, to get more experienced folks to see your request. You can always take it down when his BG goes back up.
 
I debated using the 911 tag, I'll make those changes.

He's been on this does for a while and been fine up until Tuesday. :(
 
DO NOT SHOOT THIS LOW NUMBER

Even if you are not seeing signs of a hypo this number is far too low. Kitties do not always show signs of a hypo.

Please give some HC food/syrup and retest in 20 minutes.

Some kitties will become more insulin sensitive after a hypo.
 
Mochi & Me said:
I debated using the 911 tag, I'll make those changes.

He's been on this does for a while and been fine up until Tuesday. :(
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I'm very new to this, but I can just tell you how I would feel if I saw low levels like this - I'm sorry, I know it can be super-scary in the beginning. :bighug: You'll probably want to test a bit more frequently - maybe every 20-30 minutes until the levels go up.
 
Mandy & Rex said:
Have you decided if you are doing TR or SLGS?
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Probably SLGS, but - again - I've only had him for a couple weeks and I didn't want to do anything different until I had a chance to meet his vet and get more info. This hypo thing just threw a wrench in that plan though.
 
Definitely skip this shot! When you say Mochi has been on the 2-Unit dose "for a while", how long is that? It looks like it is way too much for him. Did his former foster test him? Is your vet familiar with how Lantus works? Please remind him/her that Lantus is a "depot" insulin and is not dosed the way the "in-and-out" insulins are. With each shot Lantus leaves some of itself in the cat's body and once the "depot" is established (after about 6 cycles), it functions as a stabilizing element. The dose is determined and adjusted based on the lowest number of the cycle (the nadir), not the pre-shot number.

Welcome to Lantus Land! Be sure to read the "Stickies" (info. posts) at the top of the Lantus/Levemir forum. Lots of important information there.
 
Mandy & Rex said:
How long had he been on 2u? Were you testing?
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Honestly, I don't know. As I said, he's new to me. I've had him for a few weeks, so at least that long. I do know that he's relatively newly dx and is still in the trying to regulate phase. I really need more info, which I'm hoping to get from the Vet this evening.

Ella & Rusty & Stu(GA) said:
Did his former foster test him? Is your vet familiar with how Lantus works?
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No, she didn't. And I just tried for the first time this past weekend, but I had a lot of issues drawing blood and getting a good reading. It wasn't until Tuesday when he went hypo that desperation found a way. Also, I have not met his vet yet.

I feel woefully under-prepared for this. His foster mom said; oh, it's easy. You just give him a shot twice a day. She gave me his meds and syringes (which don't match the insulin at all, they're U-40, but she also gave me a second, unopened box of U-100's - I'm not sure if she even knows that there is a difference) and that's pretty much all I was told.
 
From intro thread:

http://www.felinediabetes.com/FDMB/threads/introducing-mochi-me.183175/


"He's on Basaglar/glargine(?) which is U-100 insulin, but the syringes they gave me are U-40. He gets 2 units twice a day. They also gave me another box of syringes, but they are U-100's. I'm not sure if the rescue knows there's a difference and I'm worried about what to do when the others run out. I will ask the vet about it when I'm there tomorrow though."

When you say you are giving 2 units is that 2 units using a U40 syringe? If so then you are actually giving 5 units of Basaglar since Basaglar is a U100 insulin.
 
Tuxedo Mom said:
When you say you are giving 2 units is that 2 units using a U40 syringe? If so then you are actually giving 5 units of Basaglar since Basaglar is a U100 insulin.
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Yes, 2 units using the U-40 syringe. And, yes, I am aware of that. But that is what his foster mom gave me and said he gets, so I didn't question it until I found this site and started reading.

Should I adjust his SS to show that he is getting 5 units?

Just tested again and he is at 45 now.
 
Mochi & Me said:
Yes, 2 units using the U-40 syringe. And, yes, I am aware of that. But that is what his foster mom gave me and said he gets, so I didn't question it until I found this site and started reading.

Should I adjust his SS to show that he is getting 5 units?

Just tested again and he is at 45 now.
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I would adjust the spreadsheet to show 5 units since that makes a big difference in advice to be offered and since in reality that is what you have been giving. 5 units is a LARGE dose for a fairly newly diagnosed kitty. If the vet and the foster Mom were shooting this higher dose and not testing, Mochi could have been having a series of hypos for awhile and this is hard on his little body. I would suggest not shooting anything for this cycle in order to allow the insulin depot to drain.

Most likely Mochi will continue to rise but part of that is from going hypo. The body;s natural defence system will release stored glucose (glucogen) to bring the glucose levels back up to safer levels. The "bounce" that it causes can show higher glucose levels for a day or several days. At this point in order to keep Mochi safe I would suggest going to 1 unit on a U100 syringe (when it is safe to shoot again) and monitoring that dose for a few days, until the bounce has cleared. You can always increase faster if necessary but a hypo can be deadly.

Since you have a box of U100 syringes, please take the U40 syringes and put them away somewhere where you won't accidently use them. If the vet said it was okay to use U40 syringes with a U100 insulin I would be leery of how much FD knowledge they have.

This post has information of the dangers of using U40 syringes with a U100 insulin:

http://www.felinediabetes.com/FDMB/threads/converting-from-u40-syringe-to-u-100.20872/#post-2025761
 
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Tuxedo Mom said:
From intro thread:

http://www.felinediabetes.com/FDMB/threads/introducing-mochi-me.183175/


"He's on Basaglar/glargine(?) which is U-100 insulin, but the syringes they gave me are U-40. He gets 2 units twice a day. They also gave me another box of syringes, but they are U-100's. I'm not sure if the rescue knows there's a difference and I'm worried about what to do when the others run out. I will ask the vet about it when I'm there tomorrow though."

When you say you are giving 2 units is that 2 units using a U40 syringe? If so then you are actually giving 5 units of Basaglar since Basaglar is a U100 insulin.
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Just a note: I raised the alarm on the intro thread about dosing glargine with a U40 syringe but I obviously was confused about the answer and mistakenly thought that it was 2 u with a U100 syringe. I'm very sorry if I added to the confusion.
 
Kris & Teasel said:
Just a note: I raised the alarm on the ontro thread about dosing glargine with a U40 syringe but I obviously was confused about the answer and mistakenly thought that it was 2 u with a U100 syringe. I'm very sorry if I added to the confusion.
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Since this issue came up on FDMB FB a short while ago I was on high alert which is why I questioned it. Mochi's Mom is aware that it is actually a higher dose with the U40 syringes, but was just following what the foster Mom and vet had advised...which was bad advice!!
 
Tuxedo Mom said:
I would adjust the spreadsheet to show 5 units since that makes a big difference in advice to be offered and since in reality that is what you have been giving. 5 units is a LARGE dose for a fairly newly diagnosed kitty. If the vet and the foster Mom were shooting this higher dose and not testing, Mochi could have been having a series of hypos for awhile and this is hard on his little body. I would suggest not shooting anything for this cycle in order to allow the insulin depot to drain.

Most likely Mochi will continue to rise but part of that is from going hypo. The body;s natural defence system will release stored glucose (glucogen) to bring the glucose levels back up to safer levels. The "bounce" that it causes can show higher glucose levels for a day or several days. At this point in order to keep Mochi safe I would suggest going to 1 unit on a U100 syringe and monitoring that dose for a few days, until the bounce has cleared. You can always increase faster if necessary but a hypo can be deadly.

Since you have a box of U100 syringes, please take the U40 syringes and put them away somewhere where you won't accidently use them. If the vet said it was okay to use U40 syringes with a U100 insulin I would be leery of how much FD knowledge they have.
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I've updated his SS and will lock the U40 syringes away. And I will definitely be talking to the vet tonight about what his dosage is supposed to be and the trouble we've been having the past few days keeping him stable.
 
I agree with the others to get rid of the U 40 syringes and do not shoot any insulin this cycle and let the depot drain. So glad that you are testing and you caught this very low number. Stay vigilant testing and steering him up with higher carb food to get him over 50 on a human meter.
 
Mandy & Rex said:
Feed him again. You want him above 50 on a human meter.
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I have fed him a whole can of Friskies Prime Filets, which is high carb. He ate most of it (left maybe a Tbsp.) I also gave him some corn syrup, which didn't go over too well as I only have a dental irrigation syringe at the moment and it can't handle something that thick/sticky. Ended up drizzling it over his food. Also gave him several Temptations treats.

He will happily eat more treats, I'm sure, but he's had enough food as far as he's concerned and won't eat anymore right now.

ETA: Silly question - how long is a cycle? 12 hours? 24 hours? I suppose I should go read the FAQs again.
 
Mochi & Me said:
Silly question - how long is a cycle? 12 hours? 24 hours? I suppose I should go read the FAQs again.
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Here, no question is a silly question!!

A cycle is 12 hours between the pre-shot numbers/insulin shots. It's fine you put the corn syrup on food. If he didn't want to eat that, you could rub some on his gums. I'm glad he's eating. Here, when a cat is too low, we don't feed much at a time so we don't fill up the cat before he is in safe numbers. A tsp or two is good. :bighug:
 
Here is a good description @Kris & Teasel posted on another thread about "bouncing"


Here's how it works:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
 
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Tuxedo Mom said:
Here's how it works:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
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That makes sense. Thank you for sharing.

Mochi's BG is 109 now
 
I didn't want to jump in earlier when you had experts helping.

Mochi is blessed to have you and your vigilance with testing :bighug: Everything is so confusing at first, but you're getting it and you're doing well! :cat:

(And yes, def put those u40s away. I donated my spare back to my Vet office to give to someone else.)
 
Mochi & Me said:
As I type this he's sniffing all over the place and that's one of the things he was doing Tuesday so I'm really worried.
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That sounds like the beginning of brain blindness (a temporary hypo symptom) to me. The cat could have been trying to use smell as a guideline and grounding point as its sight was wonky.

I hope the vet is a good one.
 
Mochi & Me said:
Mochi's BG is 109 now
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Don't feed for now-you want him to be hungry. Test again in 30 mins.

Keep your ss updated with the readings and feedings.

Lantus is a depot insulin. The 5u doses have likely created a large depot that will continue to drain insulin into circulation. There is potential for it to continue for up to 30 hours since you last shot. Pace yourself accordingly.
 
I'm at work and just quickly skimmed your condo. Now that numbers are rising, and provided you didn't give a shot, you are likely on safe ground. I'd still continue to test. Let's get Mochi's numbers stabilized and we'll work on a strategy going forward since this is clearly way too much insulin for your kitty.

Please go find some chocolate for yourself or if you're someplace where it's late enough for an adult beverage, you may want to indulge if you need to steady your nerves after this episode.
 
I agree with Sienne about testing for a while longer. Kitties can drop again, so better safe than sorry. Mochi is so lucky that you are now in charge of his care - I'd hate to think what would have happened if he was still in his foster home!
 
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Omg how scary. When this is over don't shoot until you get help here. Get some u100 syringes and toss those u40's.
 
Mochi is lucky to have you! You're doing great. I know its scary but you're handling it like a pro.
You've got very experienced eyes watching over you:bighug:
 
Mochi & Me said:
Sending a big "Thank you" to everyone for the advice and moral support! :cat:

Mochi is at 145 last check. I'm going to remove the 911 flag now. We go to the vet in 3 hours. *Fingers crossed* that s/he is good and we can get things straightened out.
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Huge learning experience, as scary as it was. We can help you going forward. Mochi is a very cute kitty! :)
 
Gill & George said:
What a baptism of fire for you
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Yes, exactly.

The vet visit went well. I was ready to be scolded (or worse), but he was very nice. He listened to me, answered all my questions, and even complemented me on being well prepared. He also gave me a sharps container and told me to bring it back when it was full.

Mochi's dose should be 2 units using U-100 needles. The mix-up appears to have happened within the rescue. The foster mom who had him before the most recent one is a pharmacy technician and she gets the rescue stuff at a discount. No one questioned the difference in the needles because they didn't even realize there was one. I'm still not clear on how long he's been getting OD'd, but I did find out that he was diagnosed in October of last year.

Also found out that he has a bad tooth that is in need of extraction, but they want his BG levels stabilized first. That would probably explain his less than pleasant breath and recent drooling.

I tested him when we got home and he's at 271 now. The vet didn't bother because he said the numbers would be useless with him bouncing all over. They'll wait until the extraction and do it while he's under.
 
Mochi & Me said:
Mochi's dose should be 2 units using U-100 needles. The mix-up appears to have happened within the rescue. The foster mom who had him before the most recent one is a pharmacy technician and she gets the rescue stuff at a discount. No one questioned the difference in the needles because they didn't even realize there was one. I'm still not clear on how long he's been getting OD'd, but I did find out that he was diagnosed in October of last year.
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Luckily this mix-up with using the wrong syringes did not have a worse outcome. It is possible that Mochi has been dropping low and bouncing high for quite a while now. The rescue SHOULD have known about using the correct syringes with the insulin or should have consulted with someone.


Mochi & Me said:
Also found out that he has a bad tooth that is in need of extraction, but they want his BG levels stabilized first. That would probably explain his less than pleasant breath and recent drooling.
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As Bobbie said in her post dental problems can cause higher glucose readings and make it hard or impossible to get glucose levels stabilized. The best approach, as long as their are no other health issues would be to have the dental done as soon as possible, then monitor carefully to see if this affects the insulin requrements.

Mochi & Me said:
Mochi's dose should be 2 units using U-100 needles.
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This is much more reasonable than the accidental 5 unit dose Mochi was getting because of using U40 syringes with a U100 insulin.However some kitties become much more insulin sensitive after a hypo and Mochi may have had a few over time. If you shoot the 2 units please be sure that you are able to test regularly for the next few days for sure to see what this dose will do. The higher numbers you are getting now are from bouncing from the hypo, as well as a skipped shot, but that will clear in the next day or two. Make sure you get a preshot reading and then ideally a +2 reading and a +4 reading and if possible even a +6 reading.
 
Bobbie And Bubba said:
Pain and /or infection will keep the numbers elevated.
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I completely agree with Bobbie. Here is a good article that you could use to talk with your vet further.

https://www.adwdiabetes.com/articles/dental-cleaning-diabetic-pets-ask-dr-joi
If the gums are inflamed, they likely are causing him discomfort. We don’t want him to be in pain! Additionally, the infection in the mouth is very likely affecting his glucose regulation. I think oral infection and urinary tract infections are 2 of the most common infections for diabetic pets, but any infection can cause insulin resistance. As I said, I do lots of dentals in my own practice, and we take full mouth digital dental X-rays on all the dental patients. It’s not uncommon to find an abscessed root on dental X-ray that looks perfectly fine if you were to simply look at the tooth. Clients often tell me that their senior pets act like puppies again after a dental. If your vet can see inflammation and significant tartar, it is definitely worth cleaning the teeth!
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As Mochi is still technically in the care of the rescue (they're paying the bills), I'm not sure how much sway I have, but I will bring it up with them. The earliest we could get him in was next Friday, but since the vet said 2 weeks, we currently have an appointment set for the 14th of September.

ETA: I also have to work around his foster mom's schedule since she has to be there.
 
Mochi & Me said:
As Mochi is still technically in the care of the rescue (they're paying the bills), I'm not sure how much sway I have, but I will bring it up with them. The earliest we could get him in was next Friday, but since the vet said 2 weeks, we currently have an appointment set for the 14th of September.
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Definitely bring it up with them. This is more important to deal with when you have a diabetic kitty because of the problems dental issues cause with FD kitties. If having a dental done can help regulate the glucose levels it is a win win situation.

With both my FD kitties I had dentals done shortly after they were diagnosed even though neither one was even close to being regulated.
 
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